With the issuance of mental health and substance abuse parity regulations, the Federal Government has set in motion enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
2.1.10
On Friday, January 29, 2010, after several months of deliberation and the receipt of comments from interested organizations and parties, including the American Mental Health Counselors Association, as a member of the Mental Health Liaison Group, the Federal Government issued new mental health parity regulations, thus setting in motion enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008.
These new parity regulations, issued jointly by the Departments of Treasury, Labor, and Health and Human Services, will affect the beneficiaries of group health plans issued by employers with more than 50 employees once set to take effect on July 1, 2010. Introduced presently as an interim final rule, these parity regulations may yet receive modifications until the official comment period, prescribed by the federal Administrative Procedures Act, ends on May 3, 2010.
AMHCA has long advocated for equal treatment of mental health services in group health plans including medical and surgical benefits in addition to mental health and substance abuse benefits. While the new parity regulations do not specifically mention licensed mental health counselors or any other cadre of licensed mental health provider, the regulations greatly affect who can seek a licensed mental health counselor's care by eliminating the ability of insurers to cap the annual and lifetime costs they pay for mental health and substance abuse services received by their insured population, while also stripping insurers of the ability to restrict their insured population's access to mental health and substance abuse services, either quantitatively, with a cap on annual sessions the insured may receive, or qualitatively, with pre-authorization requirements and case management reviews, among other requirements.
The new mental health parity regulations require group health plans offering medical and surgical benefits and mental health and substance abuse benefits to cover mental health and substance abuse benefits on par with medical and surgical benefits arising from the same service classification. The regulations lay out six classifications of coverage, including: outpatient/out-of-network, outpatient/in-network, inpatient/out-of-network, inpatient/in-network, emergency care, and prescription drugs. For example, where a private group health plan with over 50 enrollees offers its employees mental health and substance abuse benefits in addition to medical and surgical benefits, and it has no annual or lifetime spending caps, quota of sessions, or pre-authorizations governing its insured populationís access medical or surgical services on an outpatient/out-of-network basis, the mental health and substance abuse benefits offered simultaneously on an outpatient/out-of-network basis by the group plan to its insured population must also consist of no cost, quantitative (number of visits), or qualitative (pre-authorizations, case management, and consultation) treatment limitations. Additionally, there cannot be unequal deductibles required of mental health and substance abuse services versus medical and surgical services as a condition to mental health and substance abuse services, and the reimbursements accompanying them, becoming activated. Group health plans offering mental health and medical benefits characterized by quantitative and/or qualitative treatment limitations, such as a limit on number of doctor's visits or a requirement for pre-authorization, cannot apply these requirements 'more stringently' to beneficiaries of mental health and substance abuse services than those receiving medical and surgical services.
For the first time ever, "separate" deductibles will be prohibited. Where group plans offer medical-surgical benefits and mental health-substance abuse benefits, the deductibles cannot be separate. Services provided within the same classification of the six classifications must be "equal" across the continum of benefits accessed by the insured. Plans must cumulatively evaluate whether or not a deductible is satisfied. Additionally, copayments and benefit limits among the wealth of services, including medical, surgical, mental health, and substance abuse, offered in a plan must be integrated.
New mental health parity requirements apply only to plans which simultaneously offer their insured populations medical and surgical benefits as well as mental health and substance abuse benefits. To preclude insurers from evading more just and equal mental health coverage by enrolling employees in a mental health and substance abuse plan separate from a plan providing medical and surgical benefits, new parity regulations define a 'single health plan' as one in which beneficiaries simultaneously receive mental health and substance abuse benefits with medical and surgical benefits. Group health plans are not required to offer mental health and substance abuse benefits as part of their plans. The regulations neither define mental disorders that must be covered under group health plans nor expand the scope of mental health and substance abuse benefits offered by group health plans. The regulations merely require that mental health and substance abuse disorders listed under the plan be entitled to coverage in each classification for which the plan provides medical or surgical coverage.
States that have succeeded in enacting strong mental health parity laws will not see their efforts undermined by Mental Health Parity and Addiction Equity Act of 2008 regulations. These latest mental health parity provisions will preempt state laws permitting health plans offering both medical and mental health benefits to cover mental health services at a lesser capacity than medical services. The regulations go far in ensuring that group plans offering medical and surgical benefits in addition to mental health and substance abuse benefits provide services, arising from the delivery classification, at parity with each other.
Based on the positive results of nine states that have implemented some form of mental health parity legislation, the Federal Government anticipates stronger federal mental health and substance abuse parity regulations will increase the utilization of mental health services, reduce incidents of mental illness, control mental health costs, and positively affect U.S. gross domestic product. Since expenses mental health and substance abuse disorders, on average, only comprise between 3-6 percent of a group planís overall benefits, and only 8 percent of overall costs, the Departments issuing these regulations expect group plans to respond to the Wellstone-Domenici Mental Health Parity and Addiction Equity Act of 2008 by lowering cost-sharing on mental health-substance use disorder benefits, rather than raising the cost-sharing for medical-surgical benefits.[1]
To see the new mental health and substance abuse parity regulations, click the link below:
http://www.federalregister.gov/OFRupload/OFRData/2010-02167_PI.pdf
[1] Finch, R.A., Phillips K. Center for Prevention and Health Services. ìAn Employerís Guide to Behavioral Health Services: A Roadmap and Recommendations for Evaluating, Designing, and Implementing Behavioral Health Services.î National Business Group on Health 2005.